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However, she added that it would be "dreadful" to deny treatment on the basis that patients were to blame for their condition.

Hip and knee replacements are among the operations likely to be denied to those who are overweight, while smokers could miss out on heart bypasses.

The Health Minister's views on the issue, which mirror those of a growing number of medical experts, are based on what she describes as "best practice" – because operations are less likely to be successful when the patient is very fat or a heavy smoker.

However, some doctors have expressed concern that the stance could be used by some NHS trusts as a means of saving money, while others have questioned the criteria that will be used to judge an appropriate weight for surgery.

The two sides of the argument were outlined in a debate published last month in the British Medical Journal.

Prof Matthew Peters, the head of thoracic medicine at the Concord Repatriation General Hospital, Sydney, Australia, claimed that five non-smokers could be operated on for the cost of four smokers, and that their outcomes would be better.

However, Prof Leonard Glantz, of Boston University School of Public Health, in Massachusetts, said: "It is shameful for doctors to be willing to treat everybody but smokers in a society that is supposed to be pluralistic and tolerant."

A policy of encouraging smokers to give up the habit before they are granted operations was put forward last year by hospital managers in Norfolk and Newcastle-under-Lyme, Staffordshire, where Health Service trusts are millions of pounds in debt.

The Norfolk trust explained the move by saying that smokers are at increased risk of complications and take more time to recover from surgery, meaning they have longer and more expensive stays in hospital.

The policies were based on guidelines published by the Government's drug rationing body, the National Institute for Health and Clinical Excellence.

The guidelines allow trusts to take patients' lifestyles into account in deciding if a treatment would be effective.

Smokers, however, described the policy as blackmail, pointing out that they pay taxes along with non-smoking citizens.